Dr. Oliver Sacks enters the field of literature from the somewhat unlikely background of neurology, a specialty of medicine concerned with the diagnosis and treatment of diseases of nervous system. Neurologists adopt the materialistic, causal-deterministic viewpoint of science. In their clinical practice, neurologists see persons who suffer from brain tumors, injuries, infections, congenital malformations, degenerative diseases, and so on. The task of the neurologist is not only to make a diagnosis, but also to locate the disease by deducing from the symptoms the area of the brain affected.
Sacks, however, is interested not only in neurology but also in the effect of diseases of the brain on the personality or identity of the patient. He calls this synthesis a new discipline, "the neurology of identity," which is taken to be an inquiry into the causal relation between brain and the notion of 'self'. His project is not really new: Sigmund Freud made it his lifework to discover a new science, the biology of the mind, which he called psychoanalysis. Like Freud, Sacks is a Cartesian dualist interested in discovering the biological foundations of the mind.
Sacks calls his book a collection of clinical tales, which means they are narrative dramas of personal life presented as medical case histories. Popular they are indeed, as evidenced by the book's appearance on bestseller lists, but they also resemble--with all due respect to the author--medical soap opera: portraits of people with catastrophic medical illnesses which cause devastating disabilities. We identify with and sympathize with the victims of these diseases, and we root for them to overcome their demoralization and despair. Everyone has relatives or friends who have experienced medical catastrophes, and we are all vulnerable to them ourselves. How would we react if a brain tumor or Alzheimer's disease made it impossible for us to remember the past, to recognize the faces of people we love, to know who we are?
However, the neurological clinical tale is more exotic than most medical soaps, which have dramatized ad nauseum the lives of people with ordinary medical illness: terminal cancer, heart attack, lost limbs, blindness, progressive deteriorations, etc. All of these deal essentially with whole persons who lose body parts. Usually the illness precipitates a heroic, self-exalting struggle, and except for the individual who lapses into a coma or dies, there is no question of the illness depriving the individual of the basic constituents of 'self'.
The neurological clinical tale deals with people who lose parts of their minds and--Sacks wonders--possibly their souls. They lose the sense of sight or hearing, or movement. They lose the ability to recognize objects, faces, or words. Losing their memory, they lose their past and their sense of time. They lose their ability to calculate and reason and hence, to make moral judgments and decisions. Curiously, however, neurological disease not only causes deficits, but may also cause unwilled and sometimes unwanted bodily movements, sensation, and perceptions, but also visions, cognitions, precognitions, transports, and ecstasies. The field of neurology thus presents a superb opportunity for natural experiments on the nature of 'self'. How do the qualities of sensation, perception cognition, memory, will, and emotion shape the experience and presentation of 'self'? What neurological functions are essential to the preservation of 'self' and what losses are required for 'self' to become fragmented or
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